Vikas S. Sethi, DO1, Jayashree Ganatra, MD2, Ashwani Sethi, MD2, Ian Lancaster, MD1 1Largo Medical Center, Largo, FL; 2Lee Health, Fort Myers, FL
Introduction: LGIB from inflammatory bowel disease is well recognized phenomenon and can be a medical emergency. Current treatments included blood transfusions, IV Iron, optimizing medical therapy, and surgical intervention if the others are ineffective. While surgical intervention proves effective in cases of severe hemorrhage, alternative courses would be preferable. While endoscopic intervention has traditionally been ineffective, in this case, we demonstrate an effective endoscopic method to achieve hemostasis with Hemospray, deferring need for surgical intervention.
Case Description/Methods: A 15-year-old male with Crohn’s colitis was admitted with acute LGIB with a HGB of 4.1. He had been on Infliximab and steroids for outpatient maintenance therapy. With continued bleeding and transfusion requirements up to 8 U PRBCs, he was transferred to ICU. He was evaluated with a bleeding scan, EGD, Meckel’s scan and video pill cam which were negative for any upper or small intestinal source. Because of persistent hematochezia, surgical consultation was obtained for possible colonic resection. In order to avoid surgical intervention, the parents were offered colonoscopy with Hemospray with potential complications including perforation carefully discussed and explained. With continuing hemorrhage, the parents consented to this intervention. During colonoscopy, multiple areas of colon had ulcers with moderate bleeding. Hemospray was very effective in stopping bleeding from all ulcers. The patient stopped bleeding and no more transfusions were needed. He was ultimately discharged on Vedolizumab and oral prednisone with no recurrence of LGIB since this hospitalization.
Discussion: Acute LGIB has been effectively treated with Hemospray. It provides a topical adherent mechanical barrier to continued GI bleeding. The non-contact application does not cause additional mucosal damage. In the APROACH study evaluating Hemospray’s efficacy, patients with LGIB related to IBD were excluded for fear of possible perforation. However, this case demonstrates its ability to achieve hemostasis in an IBD patient, avoiding surgical intervention.
We propose that this technique may be considered carefully in such situations with a successful outcome and a viable alternative to surgical intervention
Vikas Sethi indicated no relevant financial relationships.
Jayashree Ganatra indicated no relevant financial relationships.
Ashwani Sethi indicated no relevant financial relationships.
Ian Lancaster indicated no relevant financial relationships.
Vikas S. Sethi, DO1, Jayashree Ganatra, MD2, Ashwani Sethi, MD2, Ian Lancaster, MD1. P1547 - Hemospray Hemostasis: An Effective Use in a Case of Lower GI Bleed in Crohn’s Colitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.